Orthopaedics Flashcards
(121 cards)
1
Q
What sort of criteria would you require to perform hip replacement on pt
A
Severe pain - Doesn’t respond to analgesia Tried walking aids Had physio E.g. can’t put on socks Weight loss if needed
2
Q
Knee replacement, continuing problems. Ix
A
Xray
Aspirate
3
Q
which is valgus/varus?
A
valgus = knock-kneed varus = bow legged
4
Q
4 xray features of OA
A
osteophytes
reduced joint space
subchondral sclerosis
bone/ subchondral cysts
5
Q
is fibula medial or lateral?
A
lateral
6
Q
what is trochanteric bursitis
A
inflammation of the bursa between greater trochanter and the iliotibial band/ tensor fascia lata
7
Q
describe position of leg following NOF fracture
A
shortened, ext rotated
8
Q
describe different management between intra and extracapsular NOF fracture
A
intra-capsular = blood supply to head of femur affected so replace head extra = blood supply intact so able to keep own head of femur
9
Q
In +ve trendelenburg, which side is abductor weakness?
A
Opposite to dipped side
10
Q
Describe Colles and smiths fractures
A
Colles - dorsal angulation (fell on extended wrist)
Smiths - opposite
11
Q
What age group are rotator cuff tears/injuries most common
A
Elderly
12
Q
How do you assess axiliary nerve (can be damaged in dislocation)
A
Sensation in regimental badge area. Can also pinch deltoid and ask to raise arm
13
Q
Mx options for PIP OA
A
Splint
Steroid + local inj
Joint replacement
Permanent fusion
14
Q
What is Tennis elbow and how can you simulate the discomfort O/E
A
Lateral epicondylitis
Tender over lat epichondial + cock wrist back (uses extensors which attach lat epi)
15
Q
Carpal tunnel ix + Mx
A
Nerve conduction study,
Surgical Decompression
16
Q
First movement to go in frozen shoulder
A
Ext rotation
17
Q
What causes Numbness of little finger
A
Ulnar nerve entrapment at elbow
18
Q
Mechanism of frozen shoulder + mx
A
Tightened capsule
Hydrodilatation / endoscopic cut capsule
19
Q
bowel/ gynae/ urology surgical prophylaxis Abx
A
co-amoxiclav
[if penicillin allergic - cefuroxime + metro/ gent + metro]
20
Q
thromboprophylaxis for ortho Pt on warfarin
A
stop warfarin day -4, replace with a LMW heparin e.g. tinzaparin
21
Q
what action is taken during surgery for patients on steroids and why
A
give extra hydrocort [patients can’t produce own steroids to respond to surgical stress]
22
Q
any HTN meds you need to stop pre-op and why
A
ACE inhib + ARBs
can interact w/ anaesthetic, leading to hypoTN
23
Q
factors that increase bone healing time after fracture
A
^age
mid shaft
lower limb
24
Q
what are the 3 main principles of fracture Mx? [pneumonic RMR]
A
reduction
maintainence
rehab
25
fractures common to elderly w/ osteoporosis
colles
NOF
spinal wedge fracture
26
forearm fracture, ORIF, cast. Pt now experiencing severe pain, paraesthesia, swelling. diagnosis/Mx?
cast too tight or compartment syndrome.
| split cast volar side. If no improvement, take the theatre and split fascia to release pressure
27
mx of intracapsular NOF fracture in frail 90 yr old with reduced mobility
hemiarthroplasty
28
mx of intracapsular NOF fracture in fit Pt
total hip replacement
| [or if not displaced, can sometimes keep head with DHS, then fit enough to undergo 2nd op if AVN occurs]
29
Mx of extracapsular NOF fracture
DHS or 2 nails, depending on intra/subtrochanteric
30
non-surgical Mx options for fractures
splint/brace
cast
traction - skin/skeletal
31
problems with skin traction
not much weight can be applied
| skin sores
32
priniciples of immediate ortho trauma Mx
ABC, stabilise cervical spine, rule out life-threatening.
analgesia, neurovasc status,
splint, traction,
Abx, cross match.
33
damage to common perineal nerve causes what clinical sign
foot drop
34
causes of common perineal nerve damage
```
varus knee = stretched nerve
squashed by cast/ stirrups
MS etc
disc prolapse
etc!
```
35
24 hrs post femur fracture. Pt presents w/ petechial rash, hypoxia, tachycardia. Whats happened
fat embolism syndrome [marrow > lung, like PE]
36
risk with scaphoid fractures
avn
| due to poor blood supply (artery damaged with fracture)
37
patient falls on outstretched hand.
| 3 anatomical areas to examine for tenderness in suspected scaphoid fracture
anatomical snuffbox
longitudinal compression of thumb
push on scaphoid at base of thenar eminence
38
what are the aspects of 3 point immobilization of the neck
hard collar, sand bags, tape
39
alternative names for cervical vertebrae C1 and C2
C1 atlas
| C2 axis
40
most important consequence of cervical spondylolisthesis
spinal cord compression
41
causes of spinal cord comporession
```
bone displacemnt
disc prolapse
local tumour
abscess
hameoatoma
```
42
broadly speaking , what signs are seen at the level of, and below a spinal cord compression?
LMN signs at level
UMN signs below [spastic weakness, brisk refelxes, upgoing plantars]
sensory changes below [loss of coord/ joint position sense/ vibration/ temp + pain]
43
how could cervical prolapsed disc present?
```
pain radiating to arm
stiff neck
muscle weakness
depressed reflexes
cord compression
```
44
Mx of cervical prolapsed disc
NSAIDs
collar
physio
(surg)
45
problems caused by cervical rib [congenital development of costal process of C7 vertebra]
+ Mx
brachial plexus compression
subclavian artery stenosis
[pain/numbness in hand/forearm, weakness/muscle wasting]
[weak radial pulse, forearm cyanosis]
physio to strengthen shoulder elevators, surg removal
46
whiplash Mx
```
reassure serious injury is rare
prompt return to usual activity and occupation
active mobilization
prevent disuse > chronic
analgesia
NO collar/ rest
```
47
which intervertebral discs are most likely to rupture?
L4/L5, L5/S1
48
presentaiton in disc prolapse + exam features
```
forward flexion, extension,+/- lateral flexion limited
lumbar pain,
sciatica
calf pain
sudden severe pain on e.g. coughing
weak plantar flexion/hallux ext[depends which disc]
reduced ankle jerk
reduced sensation
cauda equina
```
49
Ix of choice in suspected disc prolapse
MRI [or ct]
50
Mx of disc prolapse
brief rest, early mobilizaiton
analgesia
+/- physio
discectomy in cauda equina/ progressive muscle weakness, continuing pain
51
what Ix.s would you do in back pain lasting >4 weeks, or red flag sx
FBC, ESR, LFT, bone profile
myeloma screen if >50
XR, CT, MRI, isotope bone scan, bone biopsy
52
risk factors for discitis [or other pyogenic spine infection]
DM
imm supp
urinary surg
catheter
53
causes of cauda equine
```
disc prolapse
extrinsic tumour
primary cord tumour
spondylosis
spinal stenosis
```
54
danger signs suggestive of cauda equina
```
poor anal tone
severe back pain
saddle parasthesia
incontinence or retention of faeces or urine
paralysis +/- sensory loss
```
55
problem with delay in cauda equine diagnosis?
permanent neuro damage to sexual, bladder and bowel fn
56
what is osteomyelitis?
infection of bone
57
common organisms for osteomyelitis
staph aureus
pseudomonas
e. coli
strep
58
what are the 3 routes infection can get to a bone/ 3 categories of osteomyelitis?
acute haematogenous [through the blood]
local infection
direct inoculation from trauma or surg
59
risk factors for osteomyelitis
```
DM
prosthesis
vasc disease
imm comp
sickle cell
open fracture
```
60
what is the gold standard investigaiton for pathogen identification or uncertain diagnosis in osteomyelitis
bone biopsy and culture
61
Mx of osteomyelitis
surg - drain abscesses and remove sequestra
| 6 weeks vanc and cefotax
62
complications of osteomyelitis
septic arth
fractures
deformity
chronic osteomyelitis
63
in a painful shoulder, if all movements hurt what pathology do you consider? and if only some?
all - arthritis or capsulitis
some - impingement
64
what position might you find the arm in on examination of a posterior shoulder [glenohumeral] dislocation?
and what might you see in anterior dislocation?
internal rotation
anteromedial mass
65
name the 4 muscles of the rotator cuff
supraspinatus
infraspinatus
subscapularis
teres minor
66
describe some tests for impingement
Neers [backstroke]
Hawkins [motion in the ocean]
67
scarf test positive [forced adduction of arm across neck] suggests what pathology?
acromioclavicular joint disease
68
what imaging for rotator cuff tears
US or MRI [US quicker and cheaper and tear or no tear, MRI for quantifying muscle wasting/prognosis]
69
what is the pathology behind impingement syndrome/
the supraspinatus tendon catches under the acromion during abduction around 70-140 degrees
70
you believe pt has impingement syndrome. Give 1 other cause of painful arc
supraspinatus tendinopathy or partial rupture
calcifying tendinopathy
acromioclavicular joint arthritis
71
young weightlifter with painful arc. Diagnosis and management
acromioclavicular joint arthritis
rest, nsaids, steroid inj, [surg]
72
rupture of long head of biceps management
repair rarely indicated as function remains
73
disease associations of frozen shoulder
cervical spondylosis
DM
thyroid disease
so always check glucose and TFT
74
frozen shoulder Mx
NSAIDs
physio
steroid IA inj for pain early on
arthroscopic arthrolysis
75
what is usually the first movement restricted by hip disease?
int rotation
76
test for fixed flexion deformity
thomas test [bend good leg + fixed flexion leg will lift off couch]
77
special test for weak abductors + positive result
trendelenburg [sound side sags]
78
what causes a trendelenburg gait?
describe it
weak abductors
waddling gait, trunk tilts over weak side
79
causes of coxa vara [angle between neck and shaft of femur less than 125/ right angled - leading to leg shortening]
```
congen
SCFE
#NOF malunion
trachanteric #
rickets/pagets/osteomalacia
```
80
secondary causes of OA hip
```
AVN
paeds hip disease
age
occupation
trauma
post-op
infection
malposition
mechanical instab
osteochondritis desicans
```
81
differentials for painful hips in children
rule out SA
```
then consider:
perthes
SUFE
inflammatory arth
osteomyeltis
```
by exclusion: transient synovitis
82
4 yr old presents with pyrexia and limp due to hip pain - 2 main differentials
SA
| transient synov
83
4 prognostic clinical signs for SA [if 3 or more present, 93% chance of SA]
temp
^WCC
^CRP
non-weight bearing
84
if SA suspected in child w/ painful hip, 2 urgent Ix you'd do?
blood culture
| US guided joint aspirate
85
6 yr old with acute onset hip pain, recent viral illness. Pain in extremes of movement, bloods and radiology normal. Most likely diagnosis?
what about if other joints were involved?
- transient synov
| - consider JIA
86
6 yr old boy, hip pain and limp. All hip movements are limited, especially int. rotation + abduction. Early XR shows joint space widening, later there is small patchy femoral head. DIagnosis?
perthes disease
87
Mx of transient synovitis
self limiting w/ rest +/- analgesia
88
Mx of perthes disease
bed rest, NSAIDs
XR surveillance
+/- joint replacement
89
non-hip causes of limp in children
```
leukaemia
discitis
rickets
reactive arthritis
JIA
```
90
RFs for developmental dysplasia of hip
```
breech
caesarean due to breech
other malformations
sibling w/
^birth weight
oligohydramnios
primip or old
postmaturity
```
91
in babies who are high risk for developmental dysplasia of hip, or if neonatal exam suggests instability, what Ix should be done?
US
92
treatment for developmental dysplasia of hip [remains unstable at 6 weeks]
long term splinting in Pavlik harness [in flexion-abduction]
closed reduction + immobilisation
open reduction if failed or 18 months +
93
other than specific hips tests for developmental dysplasia, what are some other signs
unequal leg length
asymmetrical groin creases
limited abduction in flexion
older: delay in walking, waddling gait
94
risk factors for elbow osteoarthritis
osteochondritis dissecans
fractures
95
describe the pathology of osteochondritis dissecans
subchondral bone becomes avascular, may progress to fragments of bone + cartilage breaking away to form loose bodies [osteochondral fragments]
cause is unknown
96
osteochondritis dissecans - typical site? and age of patient?
lateral side of medial femoral condyle
13-21
97
what are the colloquial terms for medial and lateral epicondylitis ?
and which is more common?
```
lateral = tennis elbow
medial = golfers elbow
```
tennis
98
management of tennis elbow + prognosis
restrict activities which overload tendons
lasts 6-24 months, 90% recover within 1 yr
physio
[brace]
[surgical tendon release in severe unresponsive cases]
99
what neuropathy is occasionally associated with medial epicondylitis [golfers elbow]?
ulnar
100
causes of ulnar neuritis [cubital tunnel syndrome]
OA
RA
cubitus valgus
101
presentation of ulnar neuritis [cubital tunnel syndrome]
reduced sensation of little finger and medial half of ring finger
clumsiness of hand
weakness of hand
102
test and treatment for ulnar neuritis [cubital tunnel syndrome]
nerve cond studies
surgical decompression
103
mx of dupuytrens contracture
early disease: injectible clostridium histolyticum, percutaneous needle fasciotomy
fasciectomy
104
causes/ associations of dupuytrens contracture
```
genetic [auto dom]
smoking
DM
antiepileptics
peyronies disease
```
105
mx of ganglia
no Tx unless pain or pressure on median/ulnar nerve at wrist.
local pressure may disperse it
aspiration or surgical dissection
106
disease which increases chance of getting trigger finger [when tendon nodule prevents re-straightening of finger after flexing]
DM
107
Mx of trigger finger [when tendon nodule prevents re-straightening of finger after flexing]
rest, splinting
severe: steroid inj into region of nodule, or surgery
108
symptoms and signs in carpal tunnelsyndrome
sx: tingling/pain in thumb/ index /middle finger, worse @night, flicks/shakes wrist to relieve pain, clumsiness
signs: wasted thenar eminence, reduced sensation to lateral 3 digits, phalens [reverse prayer] + tinnels [tap]
109
what does tenderness over the lateral joint line of the knee suggest?
iliotibial band tendinitis
110
causes of anterior knee pain
patellofemoral pain syndrome [runners]
patella tendinopathy [jumpers]
Hoffa's fat pad syndrome [impingement]
Bursitis [housemaid's/clergyman's]
osgood-schlatter disease
bipartite patella
111
what actions may bring on the pain of patellofemoral pain syndrome
how is it managed?
prolonged sitting
climbing/descending stairs
recent ^sport
trauma
rest
physio/strengthening exercises
NSAIDs for pain
[rarely surgery]
112
management of patella tendinopathy [jumpers knee]
rest
NSAIDs
steroid inj around tendon
physio/exercises
113
what surgical intervention in knee OA can delay a total knee replacement by 10 years
osteotomy
114
where does aspiration of a prosthetic joint need to occur?
orthopaedic theatre, never in ED or clinic
115
how would a meniscal cyst usually present ?
and how is it managed?
young man, previous trauma, pain over joint line, swelling
arthroscopic decompression
116
examination special test for ACL tear
anterior draw
117
examination special test for knee meniscal tears
McMurray's
118
imaging investigation of choice for knee meniscal tears or cysts
MRI
119
preferred imaging technique in bakers cyst
US
120
patient with pagets disease, anterior calf hot on examination.
XR shows lytic central lesion, ass. w/ erosion of cortical surface of tibia + soft tissue swelling. Likely diagnosis?
osteosarcoma
121
when is a p value given in a study ?
can only be given if there is hypothsis testing
